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Health Professions Education 6 (2020) 31e46
www.elsevier.com/locate/hpe

Myers-Briggs Type Indicator in Medical Education: A Narrative

Review and Analysis*
Vignesh Ramachandran a,*, Asad Loya a, Kevin P. Shah a, Shreya Goyal a,
Esha A. Hansoti b, Andrew C. Caruso c,d
a
Baylor College of Medicine, Houston, TX, USA
b
University of Texas Southwestern Medical Center, Dallas, TX, USA
c
Department of Medicine, Baylor College of Medicine, Houston, TX, USA
d
Michael E. DeBakey VA Medical Center, Houston, USA
Received 30 October 2018; revised 25 March 2019; accepted 26 March 2019
Available online 11 April 2019

Abstract

Purpose: Health professionals are moving beyond traditional roles as vessels of science and are expected to exhibit excellence in
psychosocial sciences, communication, and humanities. Medical education has shifted focus to non-cognitive aspects of training,
which have been correlated with clinical performance, professionalism, interpersonal skills, and in-service exam scores. Psy-
chometric tests are a means to gauge an individual's personality and behavioral characteristics. They have been used in various
professional settings. The Myers-Briggs Type Indicator (MBTI) is an introspective psychometric questionnaire explaining an
individual's decision-making, perception, and interactions. Medicine has used the MBTI by surveying providers and trainees.
Particular interest is paid to its use in medical education. This review aims to provide a comprehensive review and analysis of MBTI
use in medical education.
Method: A PubMed search (1975e2018) was performed to identify studies addressing MBTI in medical education using a
combination of Boolean and MeSH search terms. Forty articles were included in the final review.
Results: Overall, 30% (12/40) of articles addressed MBTI in specialty/training setting selection, 52.5% (21/40) addressed MBTI
in medical curricula, and 17.5% (7/40) addressed MBTI in evaluation/selection of trainees. MBTI preferences of different
specialties showed inconsistencies. MBTI improves trainee communication skills, identifies those at risk for burnout, directs use
of personalized study resources, among other domains. Biases in medical school and residency admissions processes are
unearthed with MBTI. Furthermore, certain MBTI traits show stronger correlation with trainee clinical evaluations than board
exam scores.
Conclusion: MBTI is a potentially powerful tool for medical education. However, a large portion of studies (30%) investigate its
role in specialty choice, a domain with inconsistent results. Instead, MBTI may be better served to provide trainees with indi-
vidualized study environments/resources, enhance communication skills, and provide burnout screening and support. Furthermore,

*
None of the five above authors have competing interests.
Peer review under responsibility of AMEEMR: the Association for Medical Education in the Eastern Mediterranean Region.
* Corresponding author. Baylor College of Medicine, 1 Baylor Plaza, DeBakey Building, M-210, MS: BCM368, Houston, TX 77030-3411,
USA.
E-mail address: vigneshr@bcm.edu (V. Ramachandran).

https://doi.org/10.1016/j.hpe.2019.03.002
2452-3011/© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
32 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

it may address biases in the subjective medical school and residency interview processes and increase class psychodynamic di-
versity. New era problem-based learning and team-based learning may be enhanced with MBTI. In these ways, the application and
interpretation of this psychometric tool may advance personalized medical education in the 21st century.
© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Curriculum; Medical education; Myers-Briggs; Resident; Student

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.1. Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.2. Selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.3. Data extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.4. Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3. Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1. Specialty/practice setting selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.2. Evaluation/selection of trainees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3. Student performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.4. Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.5. Clinical skills and communication classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.6. Student study methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.7. Clinical practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.8. Study limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Other disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

1. Introduction individuals reduces implicit bias in the application

process and increases admission of underrepresented
The role of health professionals has evolved over minority students.10
the last century. Health professionals are no longer Psychometric tests gauge an individual's personality
merely vessels of science. They are expected to exhibit and behavioral characteristics. They are used various
excellence in psychosocial sciences, communication, professions such as business, sports, and law.11e13 The
and humanities. Health professions education has also Myers-Briggs Type Indicator (MBTI) is one of the
evolved to fit these new roles.1 From the addition of a most widely known and used.14 MBTI constitutes a
combined psychology-sociology section to the Medical method of explaining an individual's decision-making,
College Admission Test (MCAT) to incorporation of perception, and interactions in the world.15,16 The
problem and team-based learning activities into med- standard MBTI consists of 93 questions branching re-
ical curricula, educators have given weight to these sults into four dichotomies: Extraversion versus Intro-
traits.2e4 From the admissions standpoint, non- version, Sensing versus Intuition, Thinking versus
cognitive (personality, self-efficacy, empathy) aspects Feeling, and Judging versus Perceiving, producing 16
of the application process are given increasing impor- distinct types or preferences.14 This framework has
tance compared to cognitive determinants (MCAT and popularized its use as a vehicle for team-building,
grade point average).5,6 Furthermore, non-cognitive communication, leadership, conflict resolution, and
factors have been associated with increased clinical career advancement in various academic and profes-
performance, professionalism, interpersonal skills, and sional settings, including healthcare. 17e19
board scores in medical students and residents.7e9 One area of particular use of MBTI in healthcare is
Furthermore, assessing psychosocial aspects of within medical education. In students, MBTI has
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
been used to enhance introspection, awareness of
others, specialty selection, communication, and lead-
ership.20e23 It may also predict student performance,
decrease evaluative bias, and cater educational pro-
grams to personality types.24e27 Despite this wide-
spread use in the literature spanning decades, a review
of the literature and with subsequent analysis of its
utility is strikingly lacking.
In this study, we provide such a comprehensive re-
view and critical analysis of MBTI use in medical
trainee education (medical students and resident phy-
sicians). In doing so, we aim thorough describe the
literature present and provide frameworks for refining
and advancing the use of such psychosocial personality
indices in medical education.
2. Methods
2.1. Search strategy
A literature review was conducted using PubMed to
curate studies addressing MBTI in medical education.
Literature review was performed on August 29, 2018 for
studies between 1975 and 2018. PubMed was searched
using the following Boolean search operations: MBTI
OR Myers-Briggs OR Myers Briggs. MeSH analysis was
used to identify the following additional search terms
that were added to increase sensitivity and specificity:
Myers-Briggs Type Indicator OR Myers Briggs Type
Indicator OR Indicator Myers-Briggs Type.28
2.2. Selection criteria
Titles and abstracts of all papers were read by two
independent authors (V.R. and A.C.) for inclusion: (1)
use of MBTI in medicine/medical practice/medication
education; (2) qualitative or quantitative analysis. Ar-
ticles were excluded if: (1) full-text manuscripts not
available; (2) full-text manuscripts not in English; (3)
full-text manuscripts solely focused on dental/nursing/
pharmacy non-medicine health professions. Discrep-
ancies resolved by consensus between authors V.R. and
A.L. with third reviewer (A.C.C.) available for
adjudication.
2.3. Data extraction
After initial selection of manuscripts (Section
selection criteria), authors V.R. and A.L. independently
extracted qualitative and quantitative data from each
paper independently into Microsoft Excel spread-
sheets. Upon completion of independent data
33
extraction, authors V.R. and A.L. consolidated the
independently-derived spreadsheets. At this time, V.R.
and A.L. identified preliminary themes in the data
which were amenable to categorization. Categorization
was completed independently by V.R. and A.L. with
discrepancies resolved by consensus between authors
V.R. and A.L. with third reviewer (A.C.C.) available
for adjudication. Extracted quantitative data included
all MBTI personality trends within included studies.
Both quantitative and qualitative data were categorized
into one of seven sections: specialty/practice setting
selection, evaluation/selection of trainees, student
performance, burnout, clinical skills and communica-
tion classes, student study methods, and clinical prac-
tice. Additionally, other information extracted for
eligible studies included: authors, year, study design,
population traits, study setting, results, and analytical
findings. Microsoft Excel 2016 (Microsoft Corpora-
tion, Redmond, Washington, U.S.) was used as a
software to extract, compile, and store data.
2.4. Analysis
An extensive literature search identified 695 total
articles. After removing duplicates, 239 articles
remained. Review of these articles' titles and abstracts
removed 185 additional articles meeting exclusion
criteria (158 articles were grossly out of scope dis-
cussing MBTI outside of medicine altogether, 16 ar-
ticles discussing MBTI use in faculty not trainees, 11
articles not in English language) leaving 54 articles
eligible for full manuscript review. Of these, 13 more
were excluded (8 articles not in English language, 3
articles out of scope discussing MBTI use in faculty
not trainees, 2 articles were opinion pieces). In the end,
a final count of 40 articles were used to conduct the
review article herein and presented in (Fig. 1). The 41
articles were reviewed and grouped: 32% (13/41)
addressed MBTI in specialty/training setting selection,
51% (21/41) addressed MBTI in medical curricula, and
17% (7/41) addressed MBTI in evaluation/selection of
trainees (Table 1).
3. Results and discussion
An overview of the studies extracted can be found
in Table 1.
3.1. Specialty/practice setting selection
The MBTI has been utilized in medical students'
specialty choice and resident physicians' selection of
34 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
Fig. 1. Diagram of search strategy yielding 41 articles used in
construction of this review of the use of the Myers-Briggs Type In-
dicator in medical education.
practice setting for decades. Multiple studies show that
different MBTI preferences are associated with
different specialty choice.21,22,39,43,46,55,64 These
studies are limited and studies are often not repro-
duced. Despite being a focus of MBTI use within
medical education, distributions in MBTI preference
by specialty choice in longitudinal and cross-sectional
investigations are inconsistent calling into question its
utility in this realm.35,38,40,42,52 For instance, compared
with data from the 1960s, the preference of resident
physicians in all specialties between 1980s and 1990s
indicate a shift towards Thinking (55%; 44% in 1950s)
and Judging types (59%; 53% in 1950s) from Feeling
and Perceiving.36 Furthermore, evaluation of practice
setting by MBTI preference are lacking and insuffi-
cient to make conclusions. For instance, isolated
studies by Taylor et al. showed that there were sig-
nificant differences in MBTI between civilian and
military family practice residents, but not between the
community-based and university-based residents.
Meanwhile, Royston et al. notes that Extraverted type
students were more likely intend on practicing in a
rural setting.30,55 These studies are not large enough or
reproduced to warrant definitive conclusions.
A person's MBTI type may also change within a
few years. Taylor et al. showed that within a few
years significant preference differences developed
amongst Family Medicine residents, highlighting
the ever-changing personalities of individuals during
training.55 Therefore, evidence-based research is
needed to best guide students if the MBTI or other
personality indices are used for specialty selection.
Brown et al. show that fifty-seven percent of medical
students change their MBTI preferences between first
and fourth years. Thus, if the MBTI is useful for spe-
cialty selection, students should be administered the
MBTI prior to the residency application period in fourth
year.40 Regardless, findings vary between studies (Table
1), suggesting that the MBTI requires re-evaluation in
aiding students' specialty selection.
Colloquially, certain specialties have been charac-
terized by personalities. Surgeons are depicted as
needing to be more Extroverted and Conscientious.66
Alternatively, Internal Medicine physicians are
considered more Introverted, “thinkers”, and empa-
thetic.67 These generalizations, however, lack depth as
medicine becomes further subspecialized.68,69 For
example, Park et al. demonstrated that procedural In-
ternal Medicine fields (Cardiology and Gastroenter-
ology) have different personality traits than
Endocrinology and Primary Care.70,71 Similarly, Gen-
eral Surgery was the gateway to subspecialized fields
like Orthopaedics and Otolaryngology; however,
direct-entry residencies now exist for such fields. The
personality preferences of students entering these fields
may vary greatly and could explain why studies have
failed to identify significant differences between per-
sonality traits/preferences of those entering surgical
subspecialties or even between surgical and nonsur-
gical fields.72 Additionally, Family Medicine residents
have varying MBTI preferences by training setting,
further limiting MBTI utility in specialty selection as
medical students with different types likely seek
different characteristics in selecting training pro-
grams.55 Lastly, female medical students with Feeling
preferences were more likely to choose Family Medi-
cine than Thinking types, highlighting the impact of
gender differences in specialty choice.36 A lack of
literature on MBTI preferences of rural practitioners
and military physicians limits conclusions for these
populations.
3.2. Evaluation/selection of trainees
Medical school admissions committees are to admit
qualified students broadly representing the commu-
nities they serve. The necessity for social account-
ability and diversity is widely discussed in academic
medicine.73 As such, much research and call-for-action
has focused on ethnic and socioeconomic underrepre-
sentation.74,75 However, psychological diversity should
also be considered as personality preferences may
Table 1
Summary of papers studying Myers-Briggs Type Indicator in medical education.
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
The association between Yang et al.22 2016 835 N/A Multi- Medical Data from 2011 Retrospective Other
Myers-Briggs Type Institutional Students AAMC surveys of
Indicator and Psychiatry multiple instituitions
as the specialty choice.
A standardized patient Lifchez et al.29 2014 40 N/A Single- Residents Johns Hopkins Prospective Other
model to teach and assess institutional University School of

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

professionalism and Medicine
communication skills:
the effect of personality
type on performance
Medical student Royston et al.30 2012 141 N/A Single- Medical Pacific Northwest Retrospective Other
characteristics predictive institutional Students University of Health
of intent for rural Sciences College of
practice Osteopathic
Medicine.
Do personality differences Bell et al.31 2011 complex 2004e2009 Single- Medicat Indiana University Prospective Quasi-
between teachers and institutional Students School of medicine experimental
learners impact students'
evaluations of a surgery
clerkship?
The personal interview: Quintero et al.20 2009 complex 2004e2006 Single- Medical Penn State College of Prospective Other
assessing the potential institutional Students Medicine
for personality similarity
to bias the selection of
orthopaedic residents.
Personality types and Sefcik et al.32 2009 263 2006e2007 Single- Medical Midwestern Prospective Quasi-
performance on aptitude institutional Students University/Chicago experimental
and achievement tests: College of
implications for Osteopathic Medicine
osteopathic medical in Downer's Grove
education. Illinois
Non-cognitive variables and Neral et al.33 2008 98 3 years Single- Medical University of Prospective Other
residency choice. (unspecified) institutional Students Mississippi Medical
Center
Personality preference McNulty et al.34 2006 116 N/A Single- Medical Loyola University Prospective Other
influences medical institutional Students Stritch School of
student use of specific Medicine
computer-aided
instruction (CAI).
(continued on next page)

35
Table 1 (continued )

36
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
Personality type and Wallick et al.35 1999 1262 N/A Single- Medical Lousiana State Retrospective Other
medical specialty choice. institutional Students University School of
Medicine
Myers-Briggs type and Stilwell et al.36 2000 3987 N/A Multi- Medical Lousiana State Retrospective Other
medical specialty choice: Institutional Students University School of
a new look at an old Medicine
question.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Does the admissions Wallick et al.37 2000 complex N/A Single- Medical Louisiana State Prospective Quasi-
committee select medical institutional Students University Health experimental
students in its own Sciences Center
image?
Personality types in Wallick et al.38 1999 1797 1988e1998 Single- Medical Louisiana State Prospective Other
academic medicine. institutional Students University Health
(but compared Sciences Center
to past data
from multiple
instituitions)
Physician personality types Sliwa et al.39 1994 78 N/A Single- Residents Northwestern Prospective Quasi-
in physical medicine and institutional University Medical experimental
rehabilitation as School
measured by the Myers-
Briggs Type Indicator.
Changes in medical Brown et al.40 1994 35 1992e1993 Single- Medical University of Prospective Other
students' Myers-Briggs institutional Students Tennessee, Memphis,
“preferences” between College of Medicine
their first and fourth
years of school.
Personality, clinical Lacorte et al.41 1993 30 N/A Single- Residents Department of Prospective Other
performance and institutional Pediatrics, Brooklyn
knowledge in paediatric Hospital center and
residents. Department of
Surgery, North Shore
University Hospital
New results relating the Friedman et al.42 1988 521 students N/A Single- Medical University of North Retrospective Other
Myers-Briggs Type institutional Students Carolina at Chapel
Indicator and medical Hill School of
specialty choice. Medicine
Personality types of family Harris et al.43 1985 75 1977e1980 Single- Residents University of Utah Prospective Quasi-
practice residents as institutional Family Practice experimental
measured by the Myers- (but compared residency program
Briggs type indicator. to area
physicians)
Teaching Communication Itri et al.44 2017 21 2015 Single- Residents University of Virginia Prospective Other
Skills to Radiology institutional
Residents.
The influence of surgeon Contessa et al.45 2013 27 N/A Single- Residents Saint Raphael campus Prospective Other
personality factors on institutional of Yale New Haven
risk tolerance: a pilot Hospital in New
study. Haven, Connecticut.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Anesthesiology resident Schell et al.27 2012 36 N/A Single- Residents University of Prospective Other
personality type institutional Kentucky College of
correlates with faculty Medicine
assessment of resident
performance.
Personality types of Zardouz et al.21 2011 137 2008e2009 Single- Medical University of Prospective Quasi-
otolaryngology resident institutional Students California, Irvina experimental
applicants as described
by the Myers-Briggs
Type Indicator.
Personality profiling of the Swanson et al.46 2010 39 2009 Single- Residents Department of Prospective Other
modern surgical trainee: institutional Surgery, University of
insights into generation Minnesota
X.
Personality type and Davis et al.47 2005 63 N/A Single- Medical University of Prospective Quasi-
clinical evaluations in an institutional Students Arkansas experimental
obstetrics/gynecology
medical student
clerkship.
Resident physicians who Johnson et al.48 2003 206 N/A Single- Residents Medical University of Retrospective Quasi-
continue Balint training: institutional South Carolina experimental
a longitudinal study
1982e1999.
Residents' formal Blake et al.49 1995 36 N/A Single- Residents Department of Family Prospective Other
knowledge acquisition institutional Medicine, University
and preferred learning of Mississippi
styles. Medical Center
Family practice residents' Musham et al.50 1994 16 N/A Single- Residents Department of family Cross- Quasi-
perspectives on Balint institutional medicine, University sectional experimental
group training: in-depth of South Carolina
interviews with frequent
and infrequent attenders.
(continued on next page)

37
Table 1 (continued )

38
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
Examining whether certain O'Connell et al.51 1993 57 1991 Single- Standardized University of Illinois Prospective Quasi-
Myers-Briggs institutional Patients College of Medicine experimental
“personality preferences” and Dentistry
can be used as criteria to
select standardized
patients.
A comparative view of the Eicke et al.52 1993 44 1988e1991 Single- Residents University of Prospective Other

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Myers-Briggs type institutional Mississippi Medical
indicator. Center
Osteopathic medicine and Melnick53 1990 n/a N/A N/A N/A N/A Other
primary care practice:
plan or serendipity?
Factors associated with the Martin et al.54 1990 26 N/A Single- Residents Medical University of Retrospective Other
frequency of after-hours institutional South Carolina
in-person patient Family Medicine
consultations. Center
Personality types of family Taylor et al.55 1990 778 N/A Single- Residents Department of Family Cross- Other
practice residents in the institutional Medicine, Oregon sectional
1980s. (but used Health Sciences
national data) University School of
Medicine
Correlates of burnout Lemkau et al.56 1988 67 1984 Single- Residents Family practice Prospective Quasi-
among family practice institutional residencies associated experimental
residents. with Wright State
University.
The effect of physician Ornstein et al.57 1988 53 N/A Single- Residents Family practice Retrospective Other
personality on laboratory institutional residencies associated
test ordering for with Wright State
hypertensive patients. University.
A comparison of Rezler et al.58 1977 complex 1973e1974 Single- Medical University of Illinois Prospective Quasi-
personality types among institutional Students Medical Center experimental
female student health (and other
professionals healthcare
profession
students)
Types of family practice Quenk et al.59 1975 complex N/A Multi- Residents University of New Prospective Quasi-
teachers and residents: a Institutional Mexico, School of experimental
comparative study. Medicine
Comparison of the Leiden et al.60 1986 81 students N/A Single- Medical University of Nevada Prospective Other
abbreviated and original institutional Students School of Medicine
versions of the Myers-
Briggs Type Indicator
personality inventory.
A small-group instruction Brinton et al.61 1984 Complex N/A Single- Medical University of Utah Prospective Quasi-
experiment in medical institutional Students School of Medicine experimental
education.
Evaluation of computer- Mcnulty et al.62 2009 811 N/A Single- Medical Loyola University Prospective Other
aided instruction in a institutional Students Chicago Stritch
gross anatomy course: a School of Medicine
six-year study.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Advanced communication Ang63 2002 n/a 2001 Single- Medical University of Chicago Prospective Other
skills: conflict institutional Students Hospitals
management and
persuasion.
Square pegs in round holes: Gilligan et al.64 1999 complex 1994e1997 Single- Medical St. George's Hospital Prospective Quasi-
has psychometric testing institutional Students and in London, U.K. experimental
a place in choosing a Residents
surgical career? A
preliminary report of
work in progress.
Using a personality Bughi et al.65 2017 185 N/A Single- Medical Keck School of Prospective Other
inventory to identify risk institutional Students Medicine
of distress and burnout
among early stage
medical students.
N/A ¼ not applicable.

39
40 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
underlie performance, empathy, clinical skills, and
career choices.76e80 MBTI use has revealed peculiar
findings in admissions processes. The MBTI types of
175 first-year medical students were the same as the
MBTI types of the admissions committee on all di-
chotomies, reflecting a possible bias in the commit-
tee.37 On the other hand, longitudinal assessment of the
MBTI types of 1797 first-year Louisiana State Uni-
versity School of Medicine medical students between
1988 and 1998 show no significant changes in MBTI
types apart from a preference for Intuition over
Sensing compared to 9 other schools within a dataset
of 12 schools. This may signify that committees prefer
certain characteristics/traits in their accepted appli-
cants that limits personality diversity. 35
The personality similarities between friends in-
crease the likelihood of shared likes, dislikes, and ac-
tivity preferences, reinforcing behavior patterns.81e83
As such, admitting students with preferences mirror-
ing those of the committee is detrimental. Increasing
psychological diversity may enrich the learning envi-
ronment and produce more well-rounded physicians
who can better interact and care for diverse patient
populations. Admissions committee biases should be
addressed. To this end, some medical schools have
integrated Computer-based Assessment for Sampling
Personal characteristics (CASPer), a tool assessing
interpersonal skills and decision-making, to account
for psychological differences between applicants.84,85
Such tools should be considered more widely in
medical school admissions to promote diversity.
At the resident level, Orthopaedic faculty physi-
cians ranked Orthopaedic residency interviewees more
favorably when they shared particular personality
preferences (P ¼ 0.044), highlighting innate bias. This
bias was not present in interview rankings by basic
scientists or orthopaedic resident interviewers.20 This
questions the validity/weight given to the subjective
components of medical school/residency admissions,
such as interviews where biases may manifest and
applicants may not project their true personality
traits.21,86 However, Powis et al. do show that in-
terviews may predict academic performance and may
hold value in candidate selection.87 Therefore, a more
uniform approach to the trainee interview process may
be required to limit biases and increase validity, fair-
ness, and reliability.88
3.3. Student performance
Grading on clinical rotations have been analyzed
using MBTI. Clinical evaluations of medical students
in an Obstetrics/Gynecology clerkship did not correlate
with National Board of Medical Examiners (NBME)
scores (P > 0.05). Additionally, while NBME scores do
not correlate with the MBTI Extraversion type
(P > 0.05), a correlation was observed between Ex-
traversion preference and clinical evaluation ratings
(P ¼ 0.005).47
While preclinical medical student performance is
largely based on knowledge-based assessments, clin-
ical performance is heavily determined by subjective
evaluations by faculty and residents.89 Clinical clerk-
ship grades are important in residency selection with
some specialty program directors citing it as one of the
most crucial factors.26 Thus, identifying variables
associated with clinical clerkship grades is important.
Lee et al. surveyed a cohort of 2395 medical students
who completed one or more required clerkships (In-
ternal Medicine, Surgery, Obstetrics/Gynecology, Pe-
diatrics, Neurology and Psychiatry). The authors show
that more reserved students (in patient presentations,
answering questions) are more likely to report lower
grades in Internal Medicine, Pediatrics, Psychiatry
clerkships (all P < 0.05). Additionally, other associa-
tions with lower clerkship grades were: males in Ob-
stetrics/Gynecology and Psychiatry; Asians in
Obstetrics/Gynecology, Pediatrics and Neurology (all
P < 0.05). Alternatively, more assertive students
received lower grades less frequently in all clerkships
(P < 0.03) except Internal Medicine.89 These findings
question the validity of clinical evaluations in assessing
student performance due to possible biases and lack of
correlation with objective evaluation through shelf
exam scores. Extraversion may enable students to
openly demonstrate enthusiasm, knowledge, team-
work, and communication with evaluators and patients,
which may help to better subjective grading. Further-
more, the MBTI may explain findings by Lee et al. as a
student's response to a particular clerkship environment
may influence how they are perceived. The authors
postulate males may respond to the Obstetrics/Gyne-
cology clerkship setting with an Introversion prefer-
ence (projecting greater reticence), but with equivalent
clinical skills and knowledge to females.89,90
At the resident level, long-term clinical perfor-
mance evaluations of Anesthesiology residents are
higher for Extraverted and Sensing types than their
counterparts (P < 0.05). However, daily performance
scores are higher only for Sensing than Intuition
types (P < 0.05).27 Paediatric faculty physician
evaluations of resident knowledge is directly associ-
ated with scores on in-training exams (P < 0.01) and
Extraversion type (P < 0.01), but inversely associated
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
with age (P < 0.01).41 For fellowship selection, per-
sonal knowledge of the applicant and recommenda-
tion letters are the most important factors.91e93 As
such, resident clinical evaluations, which may influ-
ence the quality of department recommendations,
may need re-evaluation and validation of their utility.
While most MBTI and standardized testing litera-
ture show no association, a few studies do. Osteopathic
Intuition-Feeling medical students have significantly
lower scores on medical licensing exams than other
types despite no difference in medical school entrance
exam scores (P ¼ 0.002).32 At the resident level, first
and third-year Family Medicine resident in-training
exam scores showed significant differences for
Feeling (score increase of 109.4 points) versus
Thinking (72.2 points, P ¼ 0.02) and Judging (101.0
points) versus Perceptive types (60.0 points,
P ¼ 0.03).49 Similarly, Extraversion was independently
predictive of in-service scores amongst Pediatrics res-
idents.41 Possibly, certain exams may be more condu-
cive to particular personality types. These results may
be hindered by sample size or selection bias.
3.4. Burnout
Burnout increases risk of depression, anxiety dis-
orders, sleep abnormalities, fatigue/lethargy, substance
use, divorce, and suicide.94 U.S. physician burnout and
satisfaction worsened between 2011 and 2014 and now
more than 50% of U.S. physicians experience profes-
sional burnout.95 However, burnout begins early in
training. Between 28% and 45% of medical students
and 27%e75% of residents experience burnout.96 Such
findings have led to policy changes, duty hour re-
strictions, and support for trainees within a culture of
wellness.97 However, limited in the discussion of
trainee burnout is the role of personality types.
Drummond discusses character traits that may manifest
in physicians when they are burned out.98 Trainees'
perceptions of and reactions to stressors in the work
environment may predispose them to burnout differ-
ently.99 Fundamentally, the MBTI identifies how in-
dividuals interact with their environment as a product
of their interests, needs, values, and motivations. One
study examining MBTI and burnout in underclassmen
medical students showed that Extraversion types have
greater positive well-being, professional efficacy, and
lower levels of depression compared to Introversion
types (all P < 0.05).65 Studies not using MBTI show
introverted trainees are more likely to burnout than
extroverts.100e102 Hypothetically, introverts facing
stress may be less likely to discuss their struggles,
41
delaying therapeutic dialogue and mental health care.
Additionally, Perceptive, Feeling, and Intuitive Family
Medicine residents are less emotionally exhausted,
show less depersonalization, and have greater sense of
accomplishment compared to Judging, Thinking,
Introverted and Sensing peers, respectively
(P < 0.05).56 The authors postulate Perceptive types
may more readily recognize their burnout. Overall, the
MBTI may serve as a preventative “screening” tool for
first-year medical students and residents, identifying
“risk factor” preferences for burnout.
3.5. Clinical skills and communication classes
Various industries use the MBTI to improve
communication skills.18,19 This has permeated into
medical education as well. After a communication
skills workshop incorporating the MBTI, fourth-year
medical students reported increased confidence and
attitudes towards conflict management and resolu-
tion.63 Similarly, MBTI has been favorably utilized in
communication workshops for Radiology residents.44
In a majority of Intuitive-Thinking Surgery residents,
self-reported comfort in delivering bad news correlated
with evaluation by standardized patients (SP) and did
not correlate with prior education on the topic.103 With
respect to SPs, another study showed the MBTI pref-
erences of SPs do not significantly differ from those of
the general population.51 Educating and assessing
interpersonal and professional communication skills is
difficult.104 Resident often indirectly learn these skills
through observation of superiors.103 Patients and phy-
sicians differ significantly in their MBTI dimensions;
yet, current communication models assume all patients
respond similarly.105,106 To that extent, Allen et al.
present the MBTI as the most suitable tool for this
purpose as it is principally a psychometric test.107
Early incorporation of the MBTI in clinical skills
training of medical students may allow for an indi-
vidualized communication framework that can be
applied to patient care. This concept may extend to
appropriate use of body language and emotional touch
with patients, allowing for increased communication
and emotional intelligence.108
3.6. Student study methods
Students have different learning styles, which may
be due to their backgrounds and experiences.109 While
some literature has reported this not be true, other
studies have shown that different/individual learning
styles do exist.110e116 Diverse educational programs
42 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
and instructional media accommodate individualized
learning.117,118 Medical students with Sensing prefer-
ence utilize both online discussion-based and tutorial
computer-aided instruction programs more than Intui-
tive types (P < 0.05). Judging types only prefer
discussion-based applications relative to Perceiving
types, who utilize multiple modalities. These studies
emphasize that personality types can greatly influence
preferred study methods.34,62 Medicine demands life-
long learning and trainees and educators should
explore individualized approaches.106 The MBTI may
assist in doing so, especially at transition points in
training, such as for first-year medical students and
post-graduate year one residents.119
Intuitive-Feeling medical students prefer small
group courses over lectures (P < 0.05).61 Numerous
medical schools have incorporated problem-based
learning, team-based learning, and flipped classroom
models into curriculum instead of traditional large
group lectures, improving medical student satisfaction
and performance.120e122 The MBTI could be used at
the college level to identify medical schools with
curriculum models best suited for students.
3.7. Clinical practice
The MBTI has also been used to examine how resi-
dent physicians practice medicine. No differences exist
on in-person consultation frequency by MBTI temper-
ament of Family Medicine residents;54 however, Intui-
tive Family Medicine residents order 20.5% more tests
than Sensing types in outpatient settings (P < 0.05).
Surgical trainees with Thinking, Extraverted, and
Perception personality types have higher risk tolerance
than other types.57 Family Medicine residents who
completed short- and long-term Balint training, a form
of medical communication emphasizing emotional and
personal understanding and the therapeutic potential of
the doctor-patient relationship, are significantly more
likely to be Intuitive types (P < 0.05).48,50 During
medical school, students are exposed to new knowledge,
models of reasoning, and perception of information,
which often changes their MBTI preferences.58 This
may influence their practice of medicine later. As such,
different training environments may lend to different
practice behaviors, which ultimately determine the value
of care provided to patients.129
3.8. Study limitations
Several limitations exist in our study. The MBTI,
while the most commonly used personality index in
medical education research, is one of many such tests,
all of which are not validated. However, when
compared to Sixteen Personality Factor Questionnaire
and the abbreviated MBTI, the original MBTI form
shows compared results.52,60 Studies with small sample
sizes limit generalizability of results. Observational
studies and lack of longitudinal studies limit extrapo-
lation of findings. The utility of results from older
studies are questionable as specialties have evolved
over time. From our standpoint, errors in data extrac-
tion and identification of papers may diminish findings
or, theoretically, could contradict our results. Addi-
tionally, the majority of studies are American as we
excluded manuscripts not published in English. This
may be a source of potential bias given that teaching
and learning may differ in different parts of the world.
Thus, the role of MBTI and its findings within medical
education may be different in different parts of the
world. This makes our findings less generalizable.
Furthermore, personality changes can occur over time
and even throughout medical school. This concept,
coupled with papers spanning decades, makes our re-
view in some ways less applicable/translatable to
everyday practice given that older findings may not
necessarily hold true today in the ever-changing land-
scape of medical education. Lastly, it is difficult to
make generalized claims based off one or two studies.
However, given the limited scope of the literature, we
have tried to make associations and provide insights
that may probe these concepts further in more exper-
imental studies.
4. Conclusion
The MBTI is a potentially powerful tool for medical
education. However, its predominant role of assisting
trainees with specialty choice is questionable. Instead,
the MBTI may be better served to develop new-era
curricula, provide trainees with personalized study
environments (ex. Small groups), communication skills
training, and burnout support, and unearth biases in
admissions and evaluation processes. In these ways,
the MBTI may advance personalized medical educa-
tion in the 21st century.
Disclosures
None.
Ethical approval
Not applicable.
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46
Funding
None.
Other disclosure
None.
Acknowledgements
The authors would like to acknowledge Assistant
Professor of Medicine and Pediatrics Diana Ebere
Stewart, MD for her guidance and support in this
manuscript.
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